The other victims: First responders to horrific disasters often suffer in solitude

Heidi de Marco Kaiser Health News

Friday

Aug 3, 2018 at 11:46 AMAug 3, 2018 at 11:46 AM

The day a gunman fired into a crowd of 22,000 people at the country music festival in Las Vegas, hospital nursing supervisor Antoinette Mullan was focused on one thing: saving lives.

She recalls dead bodies on gurneys across the triage floor, a trauma bay full of victims. But “in that moment, we’re not aware of anything else but taking care of what’s in front of us,” Mullan said.

Proud as she was of the work her team did, she calls it “the most horrific evening of my life” — the culmination of years of searing experiences she has tried to work through, mostly on her own.

“I can tell you that after 30 years, I still have emotional breakdowns and I never know when it’s going to hit me,” said Mullan.

Calamities seem to be multiplying in recent years, including mass shootings, fires, hurricanes and mudslides.Many of the men and women who respond to these tragedies have become heroes and victims at once. Some firefighters, emergency medical providers, law enforcement officers and others say the scale, sadness and sometimes sheer gruesomeness of their experiences haunt them, leading to tearfulness and depression, job burnout, substance abuse, relationship problems, even suicide.

Many, like Mullan, are stoic, forgoing counseling even when it is offered.

“I don’t have this sense that I need to go and speak to someone,” said Mullan. “Maybe I do, and I just don’t know it.”

In 2017, there were 346 mass shootings nationwide, including the Las Vegas massacre — one of the deadliest in U.S. history — according to Gun Violence Archive, a nonprofit organization that tracks the country’s gun-related deaths.

The group, which defines mass shootings as ones in which four or more people are killed or injured, has identified 159 so far this year, through July 3.The “first responders” who provide emergency aid have been hit hard not just by recent large-scale disasters but by the accumulation of stress and trauma over many years, research shows. Many studies have found elevated rates of post-traumatic stress disorder among nurses, firefighters and paramedics. A 2016 report by the International Association of Fire Fighters found that firefighters and paramedics are exhibiting levels of PTSD similar to that of combat veterans.

Experts have found a dearth of research on treatment, insufficient preparation by employers for traumatic events and significant stigma associated with seeking care for the emotional fallout of those events.

“When we have these national disasters or have a guy take a truck and run people over … those are added stressors we aren’t prepared for,” said Jeff Dill, a former firefighter and licensed counselor.

Dill said the emotional toll of these large-scale horrific events is magnified because everyone is talking about them. They are inescapable and become emotional “trigger points.”

“Anniversaries are the hardest,” he said.

Some employers are working on developing greater peer support, he said, but it often comes after the fact rather than proactively. “We met a lot of resistance early on because of the [stoic] culture,” said Dill, who travels the country teaching mental health awareness workshops for firefighters and other emergency personnel.

He said the culture is slowly shifting — particularly because of the rise in mass public shootings across the country.